The candidate is a general internist and health services researcher committed to outcomes research in frail older patients with chronic illness. His short-term career objectives are (l) to expand the scope and depth of his independently funded research program on outcomes in frail elders and (2) to extend his skills in quantitative methods and learn new qualitative methods. Long term objectives are to be a national leader in health services research in older people, to develop a geriatric health services research laboratory, and to translate his initial research findings to future studies to measure and improve the quality of care of frail elders. In addition to focused research, career development plans include interaction with colleagues on his advisory team, a formal and informal curriculum, and development of mentoring skills. UCSF will provide an outstanding environment for his career development. Resources include a research resource lab and access to outstanding fellows within his home Division of Geriatrics, as well as the Institute on Health and Aging, and the Division of General Medicine. The goal of the applicant's research proposal is to identify the determinants of comprehensive health outcomes (mortality, functional change, hospitalization, and quality of life) in frail nursing home eligible patients who continue to live in the community. Subjects will be patients at 12 national sites of the Program of All-Inclusive Care For the Elderly (PACE), a rapidly expanding program that cares for patients in the community that have been certified as eligible for nursing homes. The first three specific aims are to determine the predictors of mortality (aim l), functional deterioration (aim 2), and hospitalization (aim 3) and to develop risk adjustment models for each of these outcomes. The fourth aim is to measure health status transitions and resource use in the last year of life. The fifth aim is to understand the determinants of quality of life, from the perspective of frail elders. The first four aims rely on a novel existing datasource (DataPACE) that includes comprehensive baseline and quarterly follow-up data about comorbid conditions, functional status, resource use, and vital status in 5982 ethnically diverse patients. The fifth aim will rely on semi-structured interviews of 60 patients at one of the PACE sites. The products of this research are a critical first step in developing methods to measure variations in outcomes and the quality of care, developing interventions to improve care of frail elders, and assessing the effectiveness of the rapidly growing PACE program.